太极拳对早期膝骨关节炎患者治疗效果及机制探讨

目的:观察太极拳对早期膝骨关节炎患者的临床疗效及初步探讨其作用机制。方法:选取我市太极拳运动员及爱好者80例,随机分为观察组和对照组,每组40例,对照组给予盐酸氨基葡萄糖胶囊(奥泰灵)治疗,观察组在对照组基础上,在专业人员的指导下进行为期五个月的太极拳锻炼。五个月后,观察其临床疗效,并初步探讨作用机制。采用膝关节等速肌力测定、视觉模拟评分(VAS)及膝关节Lysholm评分表对治疗效果进行评估。结果:对照组总有效率为67.50%,观察组总有效率为82.50%,观察组治疗效果优于对照组P<0.05;观察组治疗后膝关节屈伸肌峰力矩(PT)有明显改善,且优于对照组P<0.05;对照组治疗后屈伸肌峰力矩(PT)无明显改善,差异无统计学意义(P>0.05);治疗后观察组VAS评分及膝关节Lysholm评分改善均优于对照组(P<0.05)。结论:太极拳锻炼后可改善患者膝关节疼痛、活动受限等临床症状,优于单独口服奥泰灵治疗,可能是在一定程度上通过增加下肢肌肉力量,进而增加膝关节稳定性来改善其临床表现。     

双膝骨性关节炎患者步态特征的研究

目的:比较双侧膝骨性关节炎(knee osteoarthritis,KOA)患者与健康成年人步态特征的差异。方法:应用现代步态测试系统对双侧KOA患者及健康成年人(各50例)进行步态检测,比较并分析受试者足底各区域受力时间参数、步角、单足支撑时间。结果:双侧KOA患者足底受力时间百分比M1值明显低于健康成年人,而M2、M3值则明显高于健康成年人(均P0.05);双侧KOA患者与健康成年人步角差异无统计学意义(P0.05);双侧KOA患者单足支撑时间明显大于健康成年人(P0.05)。结论:双侧KOA患者与健康成年人的步态特征存在差异。     

太极拳对早期膝骨关节炎步态参数的影响及疗效观察

目的:观察太极拳对膝骨关节炎患者步态的影响及临床疗效观察。方法:选取我市太极拳运动员及爱好者,且患有早期KOA者72例,随机分为治疗组和对照组,每组36例。基础治疗均予以硫酸氨基葡萄糖胶囊(伊索佳)口服,治疗组进行规律太极拳锻炼,对照组进行常规功能锻炼,共进行20周,锻炼前后采用三维步态运动分析系统比较两组患者的步态运动学参数、视觉模拟评分(VAS)及骨关节炎指数评分表(WOMAC)。结果:两组治疗后步长、步频及VAS和WOMAC评分均较治疗前有改善,差异有统计学意义(P<0.05);治疗后两组步长、步频及VAS和WOMAC评分较对照组有改善,差异有统计学意义(P<0.05)。结论:太极拳锻炼对早期KOA患者步态运动学参数及临床症状有一定改善,有利于提高KOA患者生活质量及日常活动能力。     

膝骨关节炎患者伸肌肌力与疼痛和功能状况的关系

目的调查膝骨关节炎患者患肢肌力与其疼痛和功能状况之间的关系。方法对25例经放射影像学确诊且有临床症状的膝关节骨关节炎患者进行西安大略和麦克马斯特大学（WOMAC）骨关节炎指数评分和等速肌力测试。结果膝骨关节炎患者患肢伸肌肌力与WOMAC疼痛得分、WOMAC日常活动能力得分、WOMAC总分之间存在相关性（P<0.05）。结论膝骨关节炎患者的疼痛和功能状况与患肢的伸肌肌力之间存在密切关系。     

Baker's Cyst with Knee Osteoarthritis: Clinical and Therapeutic Implications

ObjectiveSeveral symptoms are common to knee osteoarthritis and Baker''s cyst. To what extent each condition contributes to the patient''s discomfort is still a matter of debate. The aim of the present study was twofold: first, to compare the burden of symptoms in patients with isolated knee osteoarthritis and patients with knee osteoarthritis associated with Baker''s cyst; second, to assess the outcomes after conservative treatments.Subject and MethodsPatients suffering from monolateral idiopathic knee osteoarthritis were enrolled. Demographic, anthropometric and clinical data (KOOS scale) were collected. Ultrasound evaluation was performed according to standard protocols. On the basis of the clinical presentation different therapeutic options were used (fluid withdrawal, hyaluronic acid and/or steroids injections).ResultsOne-hundred and thirty patients were included in the study (97 with isolated knee osteoarthritis, 33 with knee osteoarthritis and Baker''s cyst). In basal conditions, lower scores in KOOS sub-scales were observed in patients with knee osteoarthritis associated with Baker''s cyst and in patients with effusion compared with patients without effusion. At 3 months after therapy significant higher scores were observed in both groups. At 6 months the scores were unchanged in the patients without Baker''s cyst, but worsened in those with Baker''s cyst.ConclusionsThe study shows that Baker''s cysts associated with knee osteoarthritis contribute to the burden of symptoms. The conservative treatment of both conditions allows significant improvements, but in the medium term (6 months) the efficacy of the therapy declines in patients with knee osteoarthritis associated with Baker''s cyst.     

穴位按摩辅助缓解膝骨关节炎患者疼痛的护理研究

目的 研究穴位按摩对缓解膝骨关节炎患者疼痛的影响 方法 于2017年1-12月上海市静安区闸北中心医院中医骨伤科收治的膝骨关节炎患者100例,采取随机数字表法分为观察组(n=50)和对照组(n=50),对照组采用常规护理干预,观察组在此基础上采用穴位按摩,比较两组患者在干预前后膝关节疼痛评估、膝关节功能、膝关节日常活动相关指标。结果 干预后观察组患者VAS、WOMAC、ADL评分均高于对照组,差异具有统计学意义(P＜0.05)。结论 膝骨关节炎患者在常规护理的基础下应用穴位按摩能够切实有效的降低患者的膝关节疼痛感,促使膝关节功能更好地恢复,值得在临床上的普及与实施。     

Quantity and Quality of the Lower Extremity Muscles in Women with Knee Osteoarthritis

The objective of the study described here was to compare lower extremity muscle quantity and quality between individuals with and those without knee osteoarthritis (OA). Twenty-one women with knee OA (mild, n = 8; severe, n = 13) and 23 healthy patients participated. Ultrasonography was used to measure muscle thickness (MT) and echo intensity (EI) of the rectus femoris, vastus intermedius, vastus lateralis, vastus medialis, biceps femoris, gluteus maximus, gluteus medius, gastrocnemius, soleus and tibialis anterior. MTs of the vastus medialis and vastus intermedius were smaller, and EIs of the vastus medialis, vastus intermedius, gluteus medius and tibialis anterior were larger, in the severe OA group compared than in the healthy group. Compared with the healthy group, the mild OA group had decreased MT and enhanced EI. Changes in quality and quantity occurring with knee OA progression differed among muscles. In the vastus medialis, change was observed from an earlier stage.     

Effect of Soft Braces on Pain and Physical Function in Patients With Knee Osteoarthritis: Systematic Review With Meta-Analyses

ObjectivesTo systematically review and synthesize the effects of soft braces on pain and on self-reported and performance-based physical function in patients with knee osteoarthritis.Data SourcesThe following electronic databases were searched from inception to April 20, 2016: The Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, CINAHL, SPORTDiscus, Web of Science, and PEDro.Study SelectionRandomized controlled trials (RCTs) and nonrandomized controlled trials (non-RCTs), such as controlled clinical trials, crossover studies, and case-control studies, were included. Two reviewers independently screened articles and determined inclusion through predefined criteria.Data ExtractionData related to participant demographics, study design and methods, interventions, and outcomes, including numerical means and SDs, were extracted by 1 reviewer. Methodological quality assessment was independently performed by 2 reviewers.Data SynthesisEleven studies were identified, including 6 RCTs and 5 non-RCTs. The methodological quality of included RCTs was low. There was a moderate improvement in pain (standardized mean difference [SMD]=.52; 95% confidence interval [CI], .14–.89; P=.007; 284 participants) in favor of wearing a brace compared with not wearing a brace for the immediate, within-group comparison. There was a moderate improvement in pain (SMD=.61; 95% CI, .33–.89; P<.001; 206 participants) and a small to moderate improvement in self-reported physical function (SMD=.39; 95% CI, .11–.67; P=.006; 206 participants) in favor of patients receiving a soft brace versus standard care for the prolonged effect, between-group comparison.ConclusionsCurrently available evidence indicates that soft braces have moderate effects on pain and small to moderate effects on self-reported physical function in knee osteoarthritis. These findings highlight the importance of soft braces as a technique to improve pain and physical function in both the short- and long-term. Additional high-quality studies are warranted to improve confidence in the findings.     

两种治疗方法对兔膝骨关节炎软骨MMP-1的影响

目的:观察超声波及电针治疗对兔膝骨关节炎(KOA)软骨MMP-1表达的影响。方法:40只新西兰大耳兔随机分为正常组、模型组、超声波组和电针组。除正常组外,其余各组采用左膝伸膝位管型石膏固定6周制作KOA模型。模型成功后,超声波组实施3MHz脉冲式超声波治疗;电针组取梁丘、足三里(后三里)、血海、阳陵泉等穴,疏密波刺激,均每日1次。连续治疗14d后4组大耳兔均处死,光镜下观察左膝股骨内侧髁软骨及基质的HE染色改变,采用Mankin’s评分;免疫组织化学MMP-1测定。结果:与正常组比较,模型组、超声波组和电针组软骨及基质Mankin’s评分均明显升高(0.10±0.32与9.90±1.73、4.81±1.23、5.03±1.20,P<0.01),MMP-1表达也明显升高(13.89±3.10与54.65±9.27、31.64±6.69、34.87±4.23,P<0.01)。与模型组比较,超声波组和电针组两项指标均明显降低(P<0.01)。超声波组与电针组两项指标比较差异无统计学意义。结论:超声波和电针治疗均能降低KOA兔软骨中MMP-1的表达,达到治疗KOA的作用。     

Relationships of Fear, Anxiety, and Depression With Physical Function in Patients With Knee Osteoarthritis

Scopaz KA, Piva SR, Wisniewski S, Fitzgerald GK. Relationships of fear, anxiety, and depression with physical function in patients with knee osteoarthritis.

Objectives

To explore whether the psychologic variables anxiety, depression, and fear-avoidance beliefs, and interactions between these variables, are associated with physical function in patients with knee osteoarthritis (OA). We hypothesized lower levels of function would be related to higher anxiety, higher depression, and higher fear-avoidance beliefs, and that high levels of 2 of these factors simultaneously might interact to have a greater adverse effect on physical function.

Design

Cross-sectional, correlational design.

Setting

Institutional practice.

Participants

Subjects included patients with knee OA (N=182; age, mean ± SD, 63.9±8.8y; 122 women).

Interventions

Not applicable.

Main Outcome Measures

Self-report measures of function included the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index, the Lower Extremity Function Scale (LEFS), and the Knee Outcome Survey-Activity of Daily Living Scale. The Get Up and Go test was used as a physical performance measure of function. Self-report measures for psychologic variables included the Beck Anxiety Inventory, the Center for Epidemiological Studies Depression Scale, and the Fear Avoidance Belief Questionnaire-Physical Activity Scale modified for the knee.

Results

Higher anxiety was related to poorer function on the WOMAC physical function. Both high anxiety and fear-avoidance beliefs were related to poorer function on the LEFS and Knee Outcome Survey-Activity of Daily Living Scale. There was no association between the psychologic variables and the Get Up and Go test. The anxiety × depression interaction was associated with the LEFS.

Conclusions

Anxiety and fear-avoidance beliefs are associated with self-report measures of function in patients with knee OA. Depression may influence scores on the LEFS under conditions of low anxiety.     

透明质酸钠治疗膝骨关节炎的疗效观察

目的 观察透明质酸钠（SHP）对膝骨关节炎（OA）的疗效。方法 选择116例膝OA，194个膝关节进行关节腔内注射SHP，1次，周，连用3周为1个疗程，比较治疗前与治疗后临床症状（关节疼痛、关节肿胀，上下楼及下蹲有无困难）及实验室检查[血沉（ESR）、C反应蛋白（CRP）、白细胞]结果变化的人数。结果 注射治疗后患者的关节肿胀、疼痛、活动受限缓解的人数与治疗前相比有显著性差异，P〈0．05或P〈0．01；同时治疗后ESR、CRP、白细胞正常化的关节个数与治疗前相比有显著性差异，P〈0．05或P〈0．01。结论 SHP可缓解关节疼痛，减轻关节肿胀，减少关节功能障碍，是治疗膝OA的有效药物。     

膝骨关节炎患者膝屈伸肌群等速肌力及其与功能的相关性

目的观察膝关节骨关节炎(KOA)患者膝屈伸肌群等速肌力变化及其与膝关节功能的关系。方法23 例双侧KOA患者及14 名正常人进行膝屈伸肌等速肌力检查、五次坐-起试验(FTSST)、静态平衡测试、步态分析。KOA组还完成疼痛视觉模拟评分(VAS)及WOMAC骨关节炎指数评定。结果KOA组伸肌及屈肌峰力矩、峰力矩均值、平均功率、单次最佳做功及总功主患侧均小于对侧(P<0.05);峰力矩屈肌/伸肌(H/Q)百分比主患侧大于对侧(P<0.05)。组间比较,伸肌所有观察指标、屈肌平均功率KOA组均小于正常对照组(P<0.05);峰力矩H/Q 百分比KOA组大于正常对照组(P<0.05)。KOA组伸肌等速肌力峰力矩与FTSST、步行速度、步行距离、跌倒指数、VAS 评分、WOMAC-疼痛评分之间存在相关性(P<0.05),屈肌等速肌力峰力矩与FTSST、步态参数、跌倒指数、VAS评分、WOMAC评分之间无明显相关性(P>0.05)。结论KOA患者伸肌及屈肌等速肌力主患侧较对侧减弱,伸肌等速肌力较正常人减弱,膝伸屈肌肌力变化不同步。KOA患者伸肌等速肌力峰力矩与膝关节疼痛、功能之间存在相关性。     

延续性护理对膝骨关节炎出院患者康复效果的影响

目的了解延续性护理对膝骨关节炎出院患者康复效果的影响,旨在提高患者自我管理、自我康复能力,为更好地拓展延伸护理服务提供实践经验。方法 2014年9月至2015年8月,便利抽样法选取在上海市第七人民医院骨伤康复科治疗的膝骨关节炎患者74例为研究对象。根据患者病例号将患者分为两组,病例号单数者为观察组、病例号双数者为对照组,每组37例。对照组患者按照常规进行入院宣教及出院康复指导,而观察组患者在接受常规护理基础上,出院后进行延续性护理干预3个月。比较两组患者康复训练依从性、生活质量以及患者康复效果。结果出院时,两组患者康复训练依从性的差异无统计学意义(P0.05)。出院后3个月,两组患者康复训练依从性、生活质量及差异康复状况的差异均有统计学意义(均P0.05)。结论延续性护理能够提升膝骨关节炎患者的康复训练效果,改善其生活质量,促进机体康复。     

Early Intervention with Therapeutic Low-Intensity Pulsed Ultrasound in Halting the Progression of Post-traumatic Osteoarthritis in a Rat Model

Anterior cruciate ligament (ACL) and meniscus injuries are highly correlated with post-traumatic knee osteoarthritis (PTOA). The aim of this study was to examine whether early intervention with low-intensity pulsed ultrasound (LIPUS) at an intensity of 0.1 W/cm² helps delay PTOA progression. A PTOA model was established by ACL transection and meniscectomy in male Sprague–Dawley rats. LIPUS intervention (1.0 MHz, 0.1 W/cm²) started on the third day after surgery and continued for 4 consecutive wk. Histopathological analyses and immunoassays of collagen type II and matrix metallopeptidase 13 in joints were conducted. Results indicated that compared with the sham treatment, LIPUS significantly reduced Mankin scores, inflammatory cells and matrix metallopeptidase 13 expression and increased collagen type II expression in rats with PTOA (p < 0.05). Early intervention with LIPUS has beneficial effects on delaying cartilage degradation by reducing synovial inflammation and matrix metallopeptidase 13 expression, as well as enhancing collagen type II expression in cartilage.     

超声波联合非甾体抗炎药治疗膝关节骨关节炎的临床效果

目的 :对比研究超声波联合非甾体抗炎药 (NSAIDs)与传统NSAIDs治疗老年膝关节骨关节炎 (OA)的临床疗效。方法 :膝关节骨关节炎患者 132例 ,随机分为联合组、对照组 1和对照组 2各 4 4例。联合组给予环氧化酶 2 (COX 2 )抑制剂罗非昔布及超声波治疗 ,对照组 1和 2分别单独接受罗非昔布及超声波治疗 ,并比较 3组治疗后的临床效果。结果 :经 8周治疗后 ,平均Womac关节炎指数评分和平均OA严重程度指数改变程度 ,联合组均显著优于 2个对照组 (P <0 .0 5 )。结论 :通过 2种不同方法的联合治疗可使膝关节OA的临床效果得到进一步提高。     

运动疗法对膝骨关节炎的疗效观察

目的探讨运动疗法对膝骨关节炎治疗效果的影响。方法 40例膝骨关节炎患者分为对照组(n=20)和治疗组(n=20),对照组采用常规理疗、针灸、熏洗、按摩等治疗,治疗组在常规治疗基础上加入运动疗法,包括肌力训练、关节活动度训练。治疗前后采用Lysholm膝关节评分量表和视觉模拟评分法(VAS)进行评定。结果两组患者VAS和Lysholm膝关节量表评分均改善,治疗组较对照组改善更明显(P<0.01)。结论运用运动疗法能进一步改善膝骨关节炎患者膝关节功能,缓解疼痛。